=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104127281
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED STATES PHARMACEUTICAL GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2010
-----------------------------------------------------
Last Update Date | 11/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 775 TAYLOR RD SUITE 100
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-6203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-626-4284
-----------------------------------------------------
Fax | 614-626-4281
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13621 NW 12TH ST SUITE 100
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33323-2836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-903-5000
-----------------------------------------------------
Fax | 954-903-5290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. GLENN M. PARKER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-903-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------